CN107530110A

CN107530110A - Thin layer implant and method for spinal column pressure reduction

Info

Publication number: CN107530110A
Application number: CN201680021897.3A
Authority: CN
Inventors: K.李; A.蒙特洛; T.J.阿伯特
Original assignee: DePuy Synthes Products Inc
Current assignee: DePuy Synthes Products Inc
Priority date: 2015-04-13
Filing date: 2016-04-01
Publication date: 2018-01-02
Anticipated expiration: 2036-04-01
Also published as: US9717541B2; CN107530110B; US20170290613A1; WO2016167990A1; EP3081179A1; US11116551B2; JP6732789B2; US20190314063A1; EP3081179B1; JP2018514262A; US10342584B2; US20160296259A1

Abstract

Lamellae can include the various features for allowing surgeon that plate is connected to vertebra, such as multiple receiver holes for receiving spinal fixation element.Plate can be shaped, and receiver hole is located so that spinal fixation element can be installed with the exposure of the backbone of reduction and along the track of enhancing and the pull-out capacity of bone.Lamellae can include being used for the one or more features for being connected to plate and be used to receive spinal stabilization element at least one receiver head.Because receiver head can be connected to plate after plate is implanted into, so it does not constrain the angle that can install spinal fixation element or the scope of track.

Description

Thin layer implant and method for spinal column pressure reduction

Technical field

This disclosure relates to spinal column pressure reduction and fixed system, particularly thin layer implant and for being implanted into the thin layer in vertebra The method of implant.

Background technology

Laminectomy is performed on backbone to mitigate the surgical protocols of spinal cord or one or more supraneural pressure. Spinal cord or supraneural pressure can cause various symptoms, the nerve in such as neck and back pain and/or arm and leg Radicular pain.When removing thin layer, the nerve of compression can be exposed, and by removing pressure source, a part for such as interverbebral disc, vertebra Between disc segment, tumour or bone coarse projection, supraneural pressure can be mitigated in addition.

Backbone is fixed code and can performed together with laminectomy, with the phase for being aligned and/or fixing between neighbouring centrum The relation of prestige.Such backbone fixes code and generally includes multiple backbone fixation kits being positioned in targeted vertebra.These components Generally include to be configured to set the threaded holder portion of (for example, threaded connection) in vertebra, and be configured to receive and consolidate Fixed some type of spinal stabilization element (for example, rigidity or flexible link, cable, organism construction, tether, band etc.).Once These components are arranged in desired vertebra, it is possible to spinal stabilization rod is positioned and is fixed in receiver head, thus Length of the bar along patient spine is allowed to extend.Once so fixed, vertebra can be maintained at by the spinal stabilization rod installed In required spatial relationship, either until desired healing or spinal fusion occurs or continues the longer time.

Due to the complexity to be worked in backbone nearside, such laminectomy and backbone fix code can cause it is serious Patient damages and/or significant patient trauma.For example, such code is usually required backbone fixation kit directly (i.e., substantially Perpendicular to the center line of patient spine) it is delivered in the lateral block or pedicle of vertebral arch of targeted vertebra.In view of this track, due to lateral Block/the distance between pedicle of vertebral arch inlet point and midspinal line is relatively large, it is necessary to treatment site peel off significant quantity muscle and Tissue.Moreover, any slight erroneous calculations in delivering track can cause the distal part (for example, tip) of component to pass through The ridge pipe or blastopore of the nerve root left, significant patient is thus caused to damage.As another shortcoming, the generally side in vertebra The limited bone amount and/or bone density found into block portion point significantly limits the amount of the area available for contact fixation kit, by Fixation kit is effectively located at the ability in vertebra by this obstruction.

Therefore, there is still a need for for spinal column pressure reduction and/or for fixation kit to be firmly positioned in targeted vertebra, together When also make the method and system of the risk minimization of damage and associated patient trauma.

The content of the invention

The equipment, system and method for wound caused by for reducing spinal stabilization and/or depressurizing code are described herein.Herein Thin layer prosthese plate is provided, and it is configured to be positioned on vertebra after laminectomy code.Generally, lamellae can be with Plate is connected to the various features of vertebra including permission surgeon, such as receiving spinal fixation element (for example, murices Nail) multiple receiver holes.Plate can be shaped, and receiver hole is located so that spinal fixation element can be with the ridge of reduction Post exposure and along reflection bone anatomical structure and strengthen the track with the pull-out capacity of bone, such as allow longer fixed member The track of part is installed.In some aspects, lamellae can be bent upwards in front to provide space to spinal cord and prevent pair The damage of spinal cord.Lamellae can include being used at least one receiver head being connected to plate for receiving spinal stabilization element One or more features.One or more receiver heads can be selectively positioned on lamellae, to allow patient's ridge The stabilization (for example, center line, one side, bilateral etc.) of post.Because receiver head can be connected to plate after plate is implanted into, so it Do not constrain the angle that can install spinal fixation element or the scope of track.In the case of undesirable spinal stabilization, it is not required to The feature for being used for being selectively coupled on the lamellae on receiver head is used, and lamellae can be installed as being used for Replace thin layer and protect the autonomous device of spinal cord.

In some embodiments, spinal implant includes main body, and the main body has preceding surface, rear surface, upper surface And lower surface, main body can position relative to vertebra, laminectomy is performed in installation site on vertebra, in installation position Put, the first lateral end of main body receives at least a portion of the first cutting thin layer end of vertebra, and the second phase of main body To lateral end receive vertebra the second relative cutting thin layer end at least a portion so that main body across vertebra the One cutting thin layer end and the second cutting thin layer end.Implant can include the first bone anchor receiver hole, and first bone anchor connects Batter is formed and is at an angle of in the first lateral end of main body so that when main body is arranged on installation site relative to vertebra When, in the first lateral block that the bone screws inserted through the first bone anchor receiver hole extend to vertebra.Implant can also include Second bone anchor receiver hole, the second bone anchor receiver hole are formed and are at an angle of in the second lateral end of main body so that when When main body is arranged on installation site relative to vertebra, is inserted through the bone screws of the second bone anchor receiver hole and extend to the of vertebra In two relative lateral blocks.

Implant can change in any number of ways.Formed at least for example, implant can be included in main body One mating feature, receiver head can be selectively coupled to the mating feature.At least one mating feature can include The center mating feature set along the central upper-lower axis of main body so that when main body is arranged on installation site relative to vertebra When, center mating feature is positioned on the center line of vertebra.At least one mating feature can include from the center of main body The the first lateral mating feature and the second lateral mating feature of lower axis laterally offset positioning.At least one mating feature can wrap Include the screwed hole formed in main body.The upper surface of main body can limit the embossment of bending, and the embossment of the bending is configured to The spinous process of epipyramis is received when main body is arranged on installation site relative to neighbouring lower vertebra.Main body can be surrounded in main body Lower axis is bent in the heart so that when main body is arranged on installation site relative to vertebra, the preceding surface of main body limits the floating of bending Carve for protecting spinal cord.Implant can include the receiver head with mating feature, and the mating feature is configured to select Receiver head is connected to property at least one mating feature formed in main body.Receiver head may be configured to through Coupled by multiaxis, monoplane connection and single shaft connection at least one of be connected to main body.First bone anchor receiver hole can be relative Extended in the plane where the region backmost of main body with the angle in the range of about 120 degree to about 140 degree.

In some embodiments, the method for making vertebral decompression includes removing the first thin layer and the from the vertebra of patient Two thin layers, the first cutting tip and the second cutting tip are consequently formed, lamellae is inserted into patient so that the first end of plate Hold the first cutting tip of ends contact vertebra, and the second cutting tip of the second end ends contact vertebra of plate, by the One screw is inserted through the first bone screw in lamellae and into the first lateral block of vertebra, and the second screw is inserted through The second bone screw in lamellae and into the second lateral block of vertebra, lamellae is connected to vertebra, and will be thin After laminate is inserted into patient, receiver head is attached to lamellae.

After the first bone screws and the second bone screws are inserted through lamellae, receiver head can be attached to thin layer Plate.After the first bone screws and the second bone screws are inserted through lamellae, receiver head can be attached to the first bone screws With a bone screws in the second bone screws.This method, which can be included in multiple continuous vertebrals of backbone, performs full thin layer Plate resection, and lamellae is connected to each vertebral in the continuous vertebral.This method can include will Receiver head is attached in each lamellae.This method can include inserting spinal stabilization element in receiver head.Surely Determine element to can be positioned on the center line of backbone.Stable element can be positioned so that the center line laterally offset from backbone.First The distance between cutting tip and the second cutting tip can be in the range of about 15mm to about 30mm.In some embodiments In, when performing this method, only about 15mm to about 40mm vertebra is laterally exposed to the center line of vertebra.

In some embodiments, include for the first screw being inserted into the first thin layer of vertebra for treating the method for vertebra In；Second screw is inserted into the second thin layer of vertebra；After the first screw and the second screw is inserted, the first thin layer is removed With at least a portion of the second thin layer, the first cutting tip and the second cutting tip are consequently formed；Recall from vertebra parts One screw and the second screw so that the first screw and the second screw protrude from the first cutting tip and the second cutting tip respectively； And lamellae is attached to the first screw and the second screw so that the first cut end of the first end ends contact vertebra of plate Portion, and the second cutting tip of the second end ends contact vertebra of plate.

This method can be included in lamellae is attached to the first screw and the second screw after, by least one receiver Head is attached to lamellae.Lamellae is attached into the first screw and the second screw can be included lamellae from the first compressed-bit Put the second deployed position for moving into plate joint screw.

The present invention also provides claimed apparatus and method.

Brief description of the drawings

Following detailed description is read in conjunction with the figure the present invention will be more fully understood, in the accompanying drawings：

Fig. 1 is the rearview of lamellae；

Fig. 2A is the top view of Fig. 1 lamellae；

Fig. 2 B are the perspective views of Fig. 1 lamellae；

Fig. 2 C are the top views of the lamellae with adjustable curvature and in the first compression position；

Fig. 2 D are Fig. 2 C top view of the lamellae in the second deployed position；

Fig. 3 is the perspective view for the exemplary bone screws being used together with lamellae；

Fig. 4 A are the top views of the lamellae with two retaining elements, and the retaining element extends through lamellae with by plate It is connected to vertebra；

Fig. 4 B are with the perspective back view being used for the lamellae of multiple mating features of receiver head fits；

Fig. 5 A are the perspective views on Exemplary receiver head；

Fig. 5 B are the perspective views on another Exemplary receiver head；

Fig. 6 A are the perspective views on the single receiver head for being connected to lamellae；

Fig. 6 B are the perspective views on the first receiver head and the second receiver head that are connected to lamellae；

Fig. 7 A are the perspective views of the backbone bar assembly of the angle adjustable with goniometer；

Fig. 7 B are the side views of Fig. 7 A component；

Fig. 7 C are the side sectional views of Fig. 7 A component；

Fig. 8 is the thickness of the thin layer after the top view of vertebra, including laminectomy code；

Fig. 9 A are the top views of vertebra, including to the first lateral block and the distance of the leading section of the second lateral block；

Fig. 9 B are the top view of Fig. 9 A vertebra, including are similar to that each thin of the postoperative reservation of laminectomy will be being performed The distance of a part for layer；

Figure 10 is the top view of Fig. 9 A vertebra, including the distance to the first blastopore and the second blastopore；

Figure 11 A are the top views of vertebra, including murices is pinned to the entry angle in lateral block；

Figure 11 B are the top views of Figure 11 A vertebra, including bone screws are towards the entry angle of blastopore；

Figure 12 is to be connected to adjacent vertebrae and with the multiple thin of the spinal stabilization element being positioned on midspinal line The perspective view of laminate；

Figure 13 is to be connected to adjacent vertebrae and with the first spinal stabilization element from midspinal line laterally offset positioning With the perspective view of multiple lamellaes of the second spinal stabilization element；

Figure 14 A are to be connected to adjacent vertebrae and have to prolong on the center line of the first adjacent vertebrae and the second adjacent vertebrae The spinal stabilization element stretched, and multiple lamellaes of the forked section with the center line laterally offset from the 3rd adjacent vertebrae Perspective view；

Figure 14 B are the perspective views of connector, and it allows the first stable element to prolong on the center line of one or more vertebras Stretch, and allow the second stable element and the 3rd stable element to extend and from this on the center line of one or more vertebras Line is laterally offset；

Figure 15 A are can be before laminectomy be performed using to determine the saturating of the guide instrument of the track of retaining element View；

Figure 15 B are the top views of Figure 15 A for the spinous process for being connected to vertebra guide instrument；

Figure 15 C are the schematic diagrames of guide instrument；

Figure 16 A are the top views for being connected to vertebra and the guide instrument of Figure 15 C with the drill bit for extending through apparatus；

Figure 16 B are the top views of the vertebra with the retaining element extended in lateral block；

Figure 16 C are the top views of the vertebra after spinous process and thin layer are removed；

Figure 16 D are that have to proximal retraction to prepare the top view with the vertebra of the retaining element of lamellae cooperation；

Figure 16 E are the top views of the vertebra with the lamellae for being connected to retaining element；And

Figure 17 A are the perspective views with the lamellae for being used for the slit for receiving retaining element；

Figure 17 B are the end-views of Figure 17 A lamellae；

Figure 17 C are the local top views of Figure 17 A lamellae；And

Figure 18 is grown with the spinal stabilization element being arranged in receiver head and the promotion organization being coupled The top view of the lamellae of material.

Embodiment

The equipment, system and method for wound caused by for reducing spinal stabilization and/or depressurizing code are described herein.Herein Thin layer prosthese plate is provided, and it is configured to be positioned on vertebra after laminectomy code.Generally, lamellae can be with Plate is connected to the various features of vertebra including permission surgeon, such as receiving spinal fixation element (such as bone screws) Multiple receiver holes.Plate can be shaped and receiver hole is located so that spinal fixation element can be sudden and violent with the backbone of reduction Reveal and along the anatomical structure of reflection bone and enhancing and the track of the pull-out capacity of bone, such as allow longer retaining element Track is installed.In some aspects, lamellae can be bent upwards in front to provide space to spinal cord and prevent to spinal cord Damage.Lamellae can include being used at least one receiver head being connected to plate for receiving the one of spinal stabilization element Individual or multiple features.One or more receiver heads can be selectively positioned on lamellae, to allow patient spine Stable (for example, center line, one side, bilateral etc.).Because receiver head can be connected to plate after plate is implanted into, so they are not Constraint can install the angle of spinal fixation element or the scope of track.In the case of undesirable spinal stabilization, it is not necessary to make With the feature for being selectively coupled on the lamellae on receiver head, and lamellae can be installed as being used to replace Thin layer and the autonomous device for protecting spinal cord.

Some exemplaries will now be described, to understand the knot of apparatus and methods disclosed herein on the whole Structure, function, the principle of manufacture and purposes.One or more examples of these embodiments have been shown in the drawings.This area skill Art personnel should be appreciated that the apparatus and method for specifically describing and being shown in the drawings herein are nonrestrictive exemplary embodiment party Case, and the scope of the present invention is limited only by the appended claims.The feature for showing or describing with reference to an exemplary It can be combined with the feature of other embodiments.This modifications and variations are intended to be included within the scope of the present invention.

Compared with traditional decompression and/or fixing solutions, this paper system and method can provide many advantages.Example Such as, this paper system and method can be in order to the execution of laminectomy code, while reduces backbone exposure and associated trouble Person's wound.This paper system and method can also allow for spinal fixation element (for example, bone screws) to consolidate along increased bone is provided Put forth effort, reduce the track insertion of the risk pulled out and the risk that is erroneously inserted of reduction.

Open across thin layer fixing means, it can allow the stronger fixation between fixation kit and corresponding vertebra.Cause It can be positioned for the track of each fixation kit in fixation kit than traditional insertion technology from center line with bigger angle, so The resistance increase that back pulls out, and bigger surface area can be engaged by fixation kit.In view of track, fixation kit can wrap The bone anchor element of bigger (such as longer and/or wider) is included, it additionally aids stronger fixation.In addition, across thin layer delivering and fixed Position significantly reduces the risk of damage, because the distal end of fixation kit can be at an angle of during delivering away from ridge pipe, with base It is opposite perpendicular to ridge pipe and/or towards traditional track that ridge pipe is at an angle of in sheet.In addition, utilizing across thin layer delivering and positioning In, component can enter vertebra in across thin layer inlet point, and the distance for being somebody's turn to do across thin layer inlet point to midspinal line far smaller than utilizes Distance needed for traditional direct delivering method.Therefore, compared with conventional method, required lateral exposed amount can significantly drop It is low.

Fig. 1 shows to be used for vertebra, such as the exemplary of the implant of cervical vertebra, and it is commonly referred to as thin herein Laminate 100.The main body of plate 100 can have rear surface 102, and it is configured to the backbone that patient is facing away from when being implanted into plate, with And preceding surface 104, as shown in Figure 2 A and 2 B, its be configured to when being implanted into plate facing to and neighbouring patient ridge Guan Ding Position.Plate 100 can also include upper surface 100s and lower surface 100i, and relative the first lateral end and the second lateral end 100a,100b.It is special that plate 100 can be included therein the one or more for being used to coordinate with receiver head (not shown) to be formed Sign, such as along the central upper-lower axis L of plate 100_CFirst centre bore 106 of positioning, and from central upper-lower axis L_CLaterally Offset the first sidewise hole 108 and the second sidewise hole 110 set.Discuss in greater detail below, these features can allow One or more receiver heads are optionally positioned on lamellae 100 by user.Plate 100 can also include one or more Individual retaining element receiver hole, such as receiver hole 112, receiver hole 114, it can receive spinal fixation element so that plate 100 to be coupled To vertebra.

Plate can have various sizes, shape and configuration.The preceding surface and rear surface of plate can shape in a variety of ways, all Such as rectangle, square, ellipse or circle.In some aspects, plate can be dimensioned with shape in order to by multiple plates It is positioned adjacent on the thin layer of vertebra.As shown in figure 1, the upper surface 100s of plate 100 can have concave surface bended portion 116, and The lower surface 100i of plate 100 can have convex bending portion 118.Concave part 116 can correspond essentially to convex portions 118.For example, the radius of curvature of concave part 116 is substantially equal to the radius of curvature of convex portions 118.Concave part and The shape and degree of curvature of convex portions 116,118 can change, and by non-limiting example, can have compound song Line, parabolic curve etc..Generally, there is the concave part for corresponding to convex portions 118 in terms of size, shape and degree of curvature 116 can allow on the vertebra that lamellae is positioned adjacent to, and not done each other during the bending, torsion or other movements in backbone Disturb and contact.Concave part 116 can also form the embossment that the spinous process of neighbouring epipyramis can position so that spinous process does not constrain The movement of backbone, such as by being pressed against on lamellae.The radius of curvature of concave part 116 and convex portions 118 can change. For example, the radius of curvature of concave part 116 can be in the range of about 1mm to about 15mm, and the curvature of convex portions 118 is partly Footpath can be in the range of about 1mm to about 20mm.In some aspects, the radius of curvature of concave part 116 and convex portions 118 can To be substantially identical.

It should be appreciated that the height of plate 100 can change in the horizontal direction.For example, upper surface 100s and lower surface 100i The distance between can be substantially identical, moved horizontally from the first lateral end 100a of plate 100 to the second lateral end 100b, As illustrated, or the distance between upper and lower surface can change.In the illustrated embodiment, upper surface 100s and following table The distance between face 100i can be in the range of about 18mm to about 20mm.

Plate can have curve X, and as best shown in Fig. 2A to Fig. 2 B, it can surround central upper-lower axis L_CFormed, made The preceding surface for obtaining main body limits the embossment of bending, and the embossment of the bending is configured to be arranged on patient's spinal cord when being implanted into plate On.More specifically, plate 100 can surround central upper-lower axis L_CBending so that the relative lateral end 100a of plate, lateral ends Portion 100b is positioned at the front portion of the center section of plate 100.As a result, the rear surface 102 of plate 100, which can have, surrounds center upper and lower axle Line L_CSubstantially convex shape.The preceding surface 104 of plate 100, which can have, surrounds central upper-lower axis L_CSubstantially concave, Central upper-lower axis L_CSize and degree of curvature can be substantially the same with rear surface 102.Generally, curve X can be substantially There can be bigger degree of curvature equal to the curvature of the thin layer before thin layer is removed from patient, or curve X, to allow spinal cord More spaces between preceding surface 104.

In some embodiments, lamellae can have one or more features, and it allows the curvature of lamellae by making User is selectively adjusted, hinges, spring etc..For example, Fig. 2 C and Fig. 2 D show exemplary lamellae 100', its Governor motion 130' with the degree of curvature for adjustable plate.Shown governor motion 130' includes extending in the longitudinal direction Pass through the threaded rod 132' of plate.Nut 134' is threadedly coupled on the bar 132' on the rear surface of adjoining plate, and expandable member 138' is connected to the bar on the preceding surface of adjoining plate.Plate can also include depressed part 136', and it is configured to receive opening wherein Component 138' at least a portion.Plate can be formed by elastomeric material (such as so that plate towards collapsed configuration bias).Using In, user can optionally be opened and compression plate 100' by tightening or unclamping nut 134'.Especially, can tighten Nut 134' in expandable member 138' wedgings depressed part 136' and by plate will be moved to the deployed position shown in Fig. 2 D.Screw thread Bar 132' may be configured to be connected to receiver component 140' as depicted.Receiver component is explained in more detail below 140' feature.

Lamellae 100 may be configured to and vertebra, such as cervical vertebra coordinates, and can be after laminectomy code As prosthese, thin layer and spinous process both of which remove from vertebra in the Laminectomy code.Lamellae can have thickness T, it is measured as the distance perpendicular to rear surface and preceding surface 102,104.More specifically, plate 100 can have in plate 100 Lower axis L in the heart_CThe first thickness t at place₁With second at the first lateral end of plate and the second lateral end 100a, 100b Thickness t₂.The thickness t of plate 100 can be from the central upper-lower axis L of plate 100_CIncrease to the first lateral end and the second lateral end 100a,100b.This can end to plate 100 provide structural support so that plate 100 keep be securely coupled to vertebra and Extra gap can be provided for patient anatomical in the middle part of plate.

Lateral end 100a, the lateral end 100b of plate 100 can include the first lateral mating feature 120a and the second side To mating feature 120b, it can be connected to vertebra in various opening positions, such as be connected to the one of the thin layer being maintained on vertebra Part and/or it is connected to pedicle of vertebral arch.The first lateral mating feature and the second lateral mating feature can be set in a variety of ways 120a, 120b size, shape and profile, in order to the contact between plate 100 and vertebra.As shown in Figure 2 A and 2 B, first Lateral mating feature and the second lateral mating feature 120a, 120b can have semi-cylindrical or hemispheric depression 122a, 122b, be recessed 122a, and 122b has the radius of curvature in the range of about 0.5mm to about 4mm.Be recessed 122a, and 122b can be limited The first extension and the second extension 124e, 126e as best shown in Fig. 2 B, it can increase the bone contacted by plate 100 Surface area.This can help to prevent that plate 100 is upper in fore-and-aft direction or any other direction when implant 100 is connected to vertebra Move.It should be appreciated that lateral mating feature 120a, 120b can have an other configurations, and for example can be including can be regularly Engage recess, slit, tooth of vertebra etc..

Lamellae 100 can include being used for the various features for receiving retaining element, and the retaining element can be helped plate 100 Maintain into fix with vertebra and contact.Referring back to Fig. 1, lamellae 100 can have the first receiver hole 112 and the second receiver hole 114, each in the first receiver hole 112 and the second receiver hole 114 is configured to receive retaining element wherein, such as murices Nail.It will be appreciated by those skilled in the art that plate there can be any amount of receiver hole, the first lateral ends of plate are such as positioned at Two receiver holes in portion and two receiver holes being positioned on the second lateral end of plate.Receiver hole 112, receiver hole 114 Axis can be orientated in all directions relative to plate 100 so that when retaining element is inserted, retaining element penetrates vertebra Bone, such as into the lateral block (L.M.) of vertebra.Extend through in each receiver hole in receiver hole receiver hole 112,114 Mandrel line L_RAngle, θ between the central dorsoventral axis line of implant₁Can be and excellent in the range of about 20 degree to about 70 degree Selection of land is in the range of about 30 degree to about 50 degree.

For can essentially have to be configured to engage with one or more retaining elements that lamellae is used together Any kind of element of the distal part of vertebra.For example, Fig. 3 shows to be configured to the bone screws 200 for engaging vertebra.In example Property embodiment in, bone screws 200 have along its distal part 200d extend one or more screw threads 202, screw thread 202 permit Perhaps screw 200 is effectively delivered in vertebra and is positioned securely in vertebra.The portions of proximal 200p of screw 200 can With including head 204, head 204 can have one or more engagement features (not shown), the engagement features can with for Insertion instrument in driving screw 200 by plate 200 and entering to the marrow coordinates.Although retaining element can include the chi of wide scope Very little and/or shape, as described above, compared with conventional method, it is that can utilize longer element the advantages of across thin layer delivering, is passing In system method, it is organized between the center line of vertebra and lateral block and cuts and/or retract, and insert bone screws so that its is direct Extend in the lateral block of vertebra.For example, Fig. 3 is shown with length L_SBone screws 200 embodiment, its length is substantially More than the length of the bone screws utilized in traditional insertion technology, muscle must be extracted in traditional insertion technology and is organized attached Add part.Length L_SCan be in the range of about 8mm to about 25mm.The distal part 200d of screw 200 diameter D_DCan be about In the range of 1.5mm to about 4.0mm, and the diameter D on head 204_HCan be in the range of about 2.0mm to about 6.0mm.At some In embodiment, the maximum outside diameter on head 204 can be less than or equal to the distal part 200d of screw maximum outside diameter.

In use, lamellae 100 can be connected to vertebra V1 and may be used as the vacation of the first thin layer and the second thin layer Body, as shown in Figure 4 A.The first lateral lateral mating feature 120b of mating feature 120a and second can engage with vertebra V1, and It can be fixed to the upper via the first screw 200 and the second screw 200, each screw is extended in lateral block (L.M.).Plate 100 Preceding surface 104 can provide space for spinal cord, endocranium and other anatomical structures for being arranged in canalis spinalis (S.C.).

Lamellae can include one or more features, such as herein referred as receive feature one or more depressed parts or Hole, for the fixation for optionally and/or removedly with receiver head fits being used to allow backbone.It should be appreciated that thin layer Plate can have any amount of reception feature that is formed wherein, such as position each opening position onboard zero, one Individual, two, three, four, the reception features such as five.As shown in Figure 4 B, lamellae 100 can include three reception features, its Including the central upper-lower axis L along plate 100_CFirst center of positioning receives feature 106, and is positioned at the reception of the first center Feature 106 lateral the first Side direction receiving feature 108 and the second Side direction receiving feature 110.First Side direction receiving feature and second Side direction receiving feature 108,110 can be along plate H₁Longitudinal horizontal axis positioning, the axis connects from the first center is extended through Receive the longitudinal horizontal axis H of feature 106₂Skew.It is can be positioned so that is, the first center receives feature 106 less than the One Side direction receiving feature and the second Side direction receiving feature 108,110.First Side direction receiving feature and the second Side direction receiving feature 108,110 can be positioned at central upper-lower axis L_COpposite side on, such as in the illustrated embodiment, to allow stable in both directions. It should be appreciated that receiving feature can be positioned in a manner of various other along plate, such as center receives feature 106 and is located higher than First Side direction receiving feature 108 and the second Side direction receiving feature 110.Receive each reception feature in feature 106,108,110 Can be the hole formed by the rear surface of plate 100 and preceding surface 102,104, substantially perpendicular to the surface 102,104 or With the surface 102,104 inclined angles.In some embodiments, receiving one or more of feature reception feature can To be the preceding depression in the surface for not extending through plate.Receiving feature can include being easy to the various spies with receiver engagement Sign, the one or more screw threads such as extended along its inner surface, as shown in Figure 4 B.As described in further below, receptor end Portion 300 can include being configured to the characteristic threads with receiving the screw-internal thread fit in feature, such as screw 308.

Lamellae can be configured in a variety of ways, to be securely engaged spinal stabilization element (for example, rigidity or flexible stabilization Bar, tether or band).For example, receiver head can be connected to lamellae in any amount of opening position, the shape such as in plate Into reception feature any one in.This receiver head may be configured to receive spinal stabilization member securely in a variety of ways Part.For example, in the exemplary shown in Fig. 5 A, receiver head 300 can include being configured to receive stable member The " u "-shaped opening 302 of part 305.In other embodiments, opening 302 can otherwise shape so that 302 energy of opening Enough receive stable element.Receiver head can also configure in a variety of ways, so as to which stable element is fixed therein.For example, Receiver head can include surrounding its inner periphery, and can receive close mechanism and such as lock lid 306 or limit screw Stable element 305, is thus fixed in head 300 by various internal threads 304.Alternatively or in addition, receiver head can With including external screw thread and lock nut.It will be understood by those skilled in the art that receiver head can configure in a variety of ways, so as to Stable element is kept wherein.

This paper system may be configured to allow receiver head relative to the movement of lamellae, such as receiver head Relative to the pivot of plate, to allow the stabilization of complicated deformity of spine.Although receiver head can be in any number of ways Lamellae is connected to provide any desired movement and/or range of movement, but in an exemplary embodiment, receiver head It can be moved relative to plate multiaxis.It should be appreciated that receiver head can by it is various it is such in a manner of configure and/or couple, so as to This multiaxial motion is provided.For example, receiver head can include spherical part, it is located at or captured spherical in plate is formed at In seat.In some embodiments, when receiver head is connected to lamellae, receiver head can be relative to plate selectivity Ground rotates, and thus allows the opening on various receiver heads to be aligned relative to each other before stable element is by its delivering. In some embodiments, receiver head can be (the phase of monoplane (being configured to pivot along single plane) or single shaft For plate axial restraint, the ability not pivoted relative to plate).In the embodiment shown in Fig. 5 B, by close mechanism 306' The action being fixed in the 300' of receiver head can be at current angle position relative to the locking head 300' of plate 100.This can For example to be realized via the expansible anchoring element 308' for extending through receiver head 300' and entering in plate 100, anchor Determining element 308' has one or more arms, such as the first arm 310a, the second arm 310b, and it locks in stable element 305 It is moved radially outward when being scheduled in the 300' of head, similar to dry wall anchor.That is, when close mechanism 306' rotates, under it Surface contacts stable element 305.This makes stable element 305, and downwardly support 309' is moved in the 300' of receiver head.Branch Frame 309', which can have, to be placed in upper face 311' therein by stable element 305 and is connected to anchoring element 308' bottom Surface 313' so that when stable element 305 is placed in support 309' upper face 311', pin 315' between arm to Distal side drives, so that arm radially outward opens, and head 300' is locked in plate.Although receiver head can be set In various positions, as shown in Figure 6A, single receiver head 300 can be along the central upper-lower axis L of lamellae 100_CPositioning In the first center mating feature.In another embodiment, as shown in Figure 6B, first head and the second reception head are received 300a, 300b can be respectively positioned at central upper-lower axis L_COpposite side on the first lateral mating feature and second laterally match somebody with somebody Close in feature.

One or more stable elements (such as stabiliser bar) can be fixed in the receiver head in lamellae, to carry For desired therapeutic effect.Stable element can be rigidity or flexible link, tether, band, cable, biocomponents etc..Stable member Part can have the size (such as length and/or diameter) and/or shape (for example, straight, wavy profile etc.) of wide scope, its Selected according to the requirement of the anatomical structure of patient and/or surgical protocols.As shown in equally, illustrative methods can include will First stable element and the second stable element are positioned on the opposite side of center line (M.L.) of patient spine, or can include along The center line (M.L.) of patient spine simultaneously positions single stable element above.Lamellae and backbone fixation kit can be configured Into the various retaining elements of reception.By non-limiting example, suitable spinal stabilization element includes bar, tether, cable, plate etc.. Spinal stabilization element can have various configurations, and can be rigid, semirigid, bendable by non-limiting example Song, flexible etc..Spinal stabilization element can include supplementary features of the improvement system in the integration of patient's body.For example, In some embodiments, as discussed further below, spinal stabilization element can comprise additionally in fin, and soft tissue can be attached to Fin with promote integrate and post-operative recovery.

In an exemplary embodiment, spinal stabilization element is elongate rod.Although bar can be substantially straight, bar It can be bent in one or more dimensions or into curve, to allow bar to extend through multiple vertebras.Bending or curve can be adopted Any shape is taken, it is preferred that the curve of bar and backbone is complementary.Therefore, the shape of bar may be largely analogous to backbone Natural curve or backbone along center line (M.L.) desired Post operation curve.For example, bar can be bent with from a vertebra The spinous process of bone extends adjacent to the spinous process of vertebra, while maintains the tight association with the profile of backbone between the two.In some feelings Under condition, it may be predetermined that the curve of bar.In other cases, bar can include some flexibilities, to allow pole-footing according to its implantation Position shapes.Even in the case of other, bar can be completely flexible so that it can form any desired along its length Shape.Bar can also be bent in one or more planes (such as in coronal plane) or branch, with extension, such as from cervical vertebra Center line extend to one or more sides of thoracic vertebrae or other lower vertebras.Bar can also have various cross sections.For example, bar can With with circular cross section.Alternatively, the bar on midspinal line can also shape, to provide the torsional stabilizer of raising Property.For example, in one embodiment, bar can have irregular and/or rectangular cross section.

In some embodiments, the backbone bar assembly of adjustable-angle can be used.Component can be included in rotation and connect The first bar and the second bar being coupled to each other at head so that the angle between the first bar and the second bar can be adjusted.In some implementations In scheme, component can include goniometer, and it can help surgeon that the first bar and the second bar are set into desired angle Relation.Although the use that this component is disclosed herein is mainly relevant with being related to the fixation code of lamellae, the component can also For other codes, such as code is fixed using occipital bone-cervical vertebra of conventional pedicle screws.As shown in Figure 7 A, adjustable-angle Backbone bar assembly 400 may be generally comprised at pivotal point 408 the first elongate arm 402 being pivotably coupled to one another and Two elongate arms 404.One in first arm 402 and the second arm 404 can including being integrally formed therewith or join with it The goniometer 406 connect.As shown in Figure 7 B, goniometer 406 can include the multiple marks 410 represented with angle or other unit, And indicator 412 can be included, it is as the angle between the first arm 402 and the second arm 404 is conditioned and is moved, angle Degree meter 406 is calibrated such that indicator 412 and the mark corresponding to the current angular between the first arm 402 and the second arm 404 Note alignment.In some embodiments, including indicator 412 goniometer 406 can be can be from the first arm and the second arm 402,404 removals.In use, component 400 is inserted into patient, and arm 402, arm 404 can be connected to It is attached to the receiving element of patient spine.Then patient spine can be adjusted and arrives desired angle, as indicated by goniometer, Locking component or screw 409 (shown in Fig. 7 C) can be now fastened in opening 411, component is locked to desired angle, And the backbone of patient is thus fixed on the angle.Alternatively or in addition, component may be used as survey tool, with outside Section doctor provides the estimation on the angle between the various receiver heads of multiple horizontal backbones.

In addition to the above-mentioned various systems and equipment for being used for spinal column pressure reduction and/or stabilization, it is also described for providing Spinal column pressure reduction and/or stable method.Illustrative methods for alloing vertebral decompression include removing the first thin layer of vertebra Both with the second thin layer, commonly known as Laminectomy code.Can be as needed in single vertebra, continuous/neighbouring vertebra Bone, alternate vertebra etc. are upper to perform Laminectomy.Exemplary laminectomy code on cervical vertebra as shown in figure 8, its Show in the first thin layer L_AWith the second thin layer L_BIn M horizontal width W is cut from the first cutting L to second, and in cut portion First thickness T caused by place_AWith second thickness T_B.Horizontal width W can in the range of about 15mm to about 30mm, and first Thickness and second thickness can be in the range of about 2mm to about 8mm.The first thickness T of cut portion_AWith second thickness T_BCan be with Less than or equal to the first lateral lateral mating feature 120b of mating feature 120a and second of lamellae 100 thickness, in order to Lamellae 100 is connected to vertebra.For thoracic vertebrae, horizontal width W can be in the range of about 10mm to about 20mm.For waist Vertebra, horizontal width W can be in the range of about 10mm to about 35mm.For cervical vertebra, thoracic vertebrae and lumbar vertebrae, first thickness and the second thickness Spend T_A,T_BCan be in the range of about 2mm to about 8mm.

The length of the retaining element of vertebra can be selected lamellae being connected to based on the size and dimension of vertebra.Fig. 9 A Cervical vertebra C is shown with Fig. 9 B₃Regional distance.Fig. 9 A are shown respectively from the first cut portion E and the second cut portion F To the first distance D of the outward flange or leading edge of the first lateral block and the second lateral block (L.M.)₁With second distance D₂, it can be with In the range of about 10mm to about 20mm.Fig. 9 B illustrate that thin when being cut at the first cut portion A and the second cut portion B During layer, the first distance D of the length of remaining thin layer₃With second distance D₄.Distance D₃, distance D₄Can be in about 0mm to about 8mm's In the range of.For thoracic vertebrae, the first distance D₁With second distance D₂Can in the range of about 15mm to about 22mm, and first away from From D₃With second distance D₄Can be in the range of about 0mm to about 5mm.For lumbar vertebrae, the first distance D₁With second distance D₂Can be with In the range of about 15mm to about 30mm, and the first distance D₃With second distance D₄Scope that can be in about 0mm to about 10mm It is interior.

Figure 10 is shown respectively from cut portion K, cut portion J to the first blastopore F_AWith the second blastopore F_BThe first distance D₅ With second distance D₆, it can be in the range of about 10mm to about 20mm.Based on these measurements, for lamellae 100 to be fixed To the retaining element of cervical vertebra, such as bone screws, there can be distal side bone bonding part, it has the model in about 10mm to about 20mm Length in enclosing and the width in the range of about 2mm to about 8mm.Do not have the fixed member of the thoracic vertebrae of lateral block for penetrating Part, retaining element can have distal side bone bonding part, and it has the length in the range of about 15mm to about 22mm.For wearing Also the retaining element of the lumbar vertebrae without lateral block, retaining element can have distal side bone bonding part thoroughly, and it has about Length in the range of 15mm to about 30mm.

Retaining element is to cervical vertebra C₃Lateral block (L.M.) in track shown in Figure 11 A to Figure 11 B.The entry angle Can be relative to the center line L of vertebra_MTo limit.Horizontal axis H₃It is also shown as extending between the first thin layer and the second thin layer, greatly Cause will be from vertebra C₃Cutting is so that vertebra C₃Depressurize and receive at the part of lamellae.As shown in Figure 11 A, retaining element Track may extend through pedicle of vertebral arch and enter in the core of lateral block, and can be relative to the center line L of vertebra_MIt is in About 60 degree of angle, θ_MAX.As shown in Figure 11 B, the track of retaining element can be orientated towards the lateral edge of blastopore, and can be with Minimum angles θ is limited for retaining element_MIN, angle, θ_MINRelative to the center line L of vertebra_MIt is about 40 degree.For thoracic vertebrae and lumbar vertebrae, Gu Determine the angle, θ that the track of element may be in the range of about 20 degree to about 70 degree_MINTo θ_MAX.It should be appreciated that based on specific Patient anatomy and other factors, θ_MINTo θ_MAXCan be more than or less than the nonrestrictive example values specified herein and Scope.

Retaining element can be inserted in these defined angular ranges so that the farthest side end of retaining element is penetrated into In vertebra, the lateral block of such as cervical vertebra, and do not extend in nerve root or vertebral artery blastopore and/or penetrate through the appearance of vertebra Face.After Laminectomy code, retaining element penetrates in the entrance of the cutting part office of thin layer and lateral block can be with The screw longer than in traditional insertion technology is allowed to insert in vertebra.This can improve the fixation between retaining element and bone, and And retaining element is helped prevent to be pulled out after surgical protocols from bone.Use two for extending through plate and entering in vertebra Or more retaining element can also resist pull-out.In addition, retaining element (its can than in being placed in traditional retaining element more Laterally extending) angle that can install can provide the resistance of the increase to acting on the pullout forces in backward directions.

With reference to figure 12, can include fixing multiple lamellaes of type described herein for the method that cervical midline is fixed To multiple horizontal backbones.Especially, method can include the first vertebra V that the first lamellae 100 is fixed to patient₁, will First receiver head 300 is fixed to the first lamellae 100, and the second lamellae 100 is fixed to the second vertebra V of patient₂, and And the second receiver head 300 is fixed to the second lamellae 100.Two bone screws 200 can pass through in across thin layer track Lamellae and insert each and enter each vertebra V₁Vertebra V₂Lateral block in, with fixation fixed with its respective vertebra The lamellae of engagement.In the embodiment described, the receiver head 300 of lamellae 100 is positioned at patient spine Center line (M.L.) on be aligned.Then spinal stabilization element 305 can be fixed on the center line (M.L.) of patient spine The first receiver head 300 and the second receiver head 300.In some embodiments, extra vertebra water can be included It is flat.For example, also as shown in figure 12, this method can include the 3rd lamellae 100 being fixed to the 3rd vertebra V3, and the 3rd is received Device head 300 is connected to the 3rd lamellae, and stable element 305 is fixed into the 3rd receiver head.In some embodiment party In case, this method can include receiver head being fixed to through one or more in lamellae and the bone screws 200 inserted Individual bone screws.It should be appreciated that lamellae need not have the one or more for being used for receiving stable element) receiver head, and And can be alternatively for replacing thin layer and protect spinal cord, rather than provide in multiple vertebrals fixed or stably.

Lamellae can be arranged in the continuous adjacent vertebrae level of backbone, or can alternatively be connected to the friendship of backbone For level.As previously mentioned, if it is desired, plate can be included in the embossment formed in its upper surface, or can be with its other party Formula is dimensioned and shape, to allow plate to be connected to neighbouring vertebra, wherein each vertebra has before plate is connected to it The Laminectomy code performed thereon.This paper technology is different from needing some of single laminectomy on vertebra Existing code/prosthese, wherein the single laminectomy on the first vertebra performs on the first side of center line, and Single laminectomy in two adjacent vertebraes performs, etc. on the second side of center line.This paper technology is also different from tradition Code/prosthese because surgeon need not from lateral block remove tissue or otherwise expose lateral block, lamellae can To be connected to the vertebra with Laminectomy, and lamellae may be used as the protection element for spinal cord.As described above, Presently disclosed method allows the vertebra for any amount of lamellae being delivered and being navigated to any quantity and/or pattern.At it In his embodiment, this method can include any amount of lamellae (for example, 1,3,4,5 etc.) and any amount of receiver Head (for example, 0,1,2,3,4,5,6 etc.), its be configured to receive and fix any desired length single or multiple backbones it is steady Determine element.In addition, lamellae can be fixed to successive vertebra, every a vertebra, every four vertebras, or needed for given code And/or any other preferable pattern.This multifunctionality allows surgeon to select optimal vertebra position to be used to deliver and position Lamellae and stable element.

Figure 13 shows that wherein three lamellaes are fixed to the illustrative methods of continuous adjacent vertebrae.Each lamellae 100 The the first receiver head 300a and the second receiver that positioning is laterally offset from the center line (M.L.) of patient spine can be included Head 300b, the first receiver head 300a is positioned on the first side of midspinal line (M.L.), and the second receiver head 300b is positioned on the second opposite side of midspinal line (M.L.).Similar to the embodiment above, lamellae 100 can be with various Pattern and/or configuration are delivered to vertebra V₁, vertebra V₂, vertebra V₃, so as to more from the required position that center line (M.L.) is offset positioning Individual stable element, such as two stabiliser bar 305a, stabiliser bar 305b.In some embodiments, similar to the above, thin layer Plate can be connected to every a vertebra, every four vertebras etc..In brief, this method can include being positioned at any quantity And/or any amount of lamellae in the targeted vertebra of pattern, so as to which at least one stable element is firmly positioned in into the phase The position of prestige.

In another illustrative methods shown in Figure 14 A, bifurcated or the stable element 305' of branch can be used.Example Such as, stable element 305' can substantially Y shape and can have the first arm 307a, the second arm 307b and the 3rd arm Portion 307c.First arm and the second arm 307a, 307b can be extended relative to the 3rd arm 307c with angle of inclination.Shown In embodiment, the first arm and the second arm 307a, 307b are set less than the 3rd arm 307c, and via the first pedicle of vertebral arch Screw and the second pedicle screw 200 are fixed to vertebra V3.3rd arm 307c can be fixed to via corresponding lamellae 100 One or more vertebras (for example, shown vertebra V1, V2).Bar configuration can allow bar position relative to backbone from center line The lateral or offset orientation along the length of bar is changed into positioning.It is this location receivers head and allow customize stable element In flexibility can allow surgeon using this paper lamellae come correct complexity deformity of spine.

In another illustrative methods shown in Figure 14 B, it can replace using connector 500 or be added to bifurcated Stable element.Connector 500 can include the central cross part 502 with multiple mating features 504 from its extension, ridge Mast 506 or other stabilizing members can be connected to the mating feature 504.Stop although mating feature 504 is shown to have locking The female socket of dynamic screw, but it is to be understood that can instead or in addition using for by bar be attached to connector it is various its His structure, such as fixture.Shown connector 500 has forked Y shape shape, and it can allow the first stable element 506A to position Above the center line of one or more vertebras, and the second stable element and the 3rd stable element 506B, 506C lateral register in The center line of other one or more vertebras and it is positioned on the opposite side of the center line.Stable element 506 can use this paper institutes State the lamellae of type or be fixed to vertebra using traditional bone anchor.Flexibility that receiver head positions on lamellae and Forming bar can also allow surgeon to correct complicated deformity of spine to the ability that bar connects.

Method for treating one or more vertebras can be included in patient's body formed one or more otch and Retraction muscle and tissue are with into targeted vertebra, for example, cervical vertebra.Laminectomy can be performed in targeted vertebra, such as By forming the first cutting mouth at or near the first thin layer, and the second cutting is formed at or near the second offside thin layer Mouthful, and remove the first thin layer and the second thin layer from patient's body.In some embodiments, for cervical vertebra, thin layer cutting mouth The distance between can in the range of about 15mm to about 30mm, and retract muscle/tissue so that its exposure muscle/tissue Lateral distance can be in the range of about 15mm to about 40mm.Generally, the degree of exposure of the vertebra of this paper technologies can be less than Wherein retaining element is inserted directly into the legacy procedures in lateral block rather than through thin layer.This can reduce the wound to caused by patient Hinder and be easy to heal, because larger otch and larger dissection tend to increase losing blood for patient in a lateral direction.Because Select size, shape and the curvature of lamellae so that retaining element extends through thin layer, so surgeon does not need exposed side To block, and therefore degree of exposure is less than legacy procedures.The cutting mouth formed in vertebra can be by shave, formation profile or with it He changes mode, to prepare the cutting surfaces for the lateral end for being used to be connected to lamellae.

Lamellae may be inserted into patient and be positioned at installation site, for example, plate the first lateral end contact and/or Receive the second lateral end contact of the first cut portion of vertebra and plate and/or receive the second cut portion of vertebra, make Plate is obtained across the first of the vertebra position for cutting thin layer end and the second cutting thin layer end.One or more retaining elements can be with Inserted through plate and into vertebra.For example, the first retaining element (for example, bone screws) can be passed through to the first receiver hole in plate Insertion, and the second retaining element (for example, bone screws) can be passed through the second receiver hole in plate insert.In some embodiment party In case, each distal part in retaining element can be penetrated into the lateral block of vertebra, and this can improve fixation by force Degree.Lamellae need not have the receiver head/stable element being coupled, and may be used as protecting spinal cord without making ridge The stable thin layer prosthese of post.The shortage on receiver head can provide enough gaps in order to be inserted along track disclosed herein Enter retaining element, this minimizes or eliminated the extra needs laterally exposed to vertebra.

In other embodiments, one or more receiver heads can be connected to lamellae to allow the stabilization of backbone Both with the protection of spinal cord.In such embodiment, positioned before lamellae is inserted into patient or by lamellae After patient's body and insertion bone screws or other retaining elements are with before or after attaching a plate to vertebra, one or more Receiver head can be connected to lamellae., can be with by installing bone screws before one or more receiver heads are attached Enough gaps are provided for surgeon, to insert bone screws along track disclosed herein, this minimizes or eliminated to vertebra Extra laterally exposed needs.Receiver head is inserted after lamellae is positioned at patient's body can also improve surgeon Navigation anatomical structure ability.Insertion lamellae, secure the plate to vertebra via retaining element and connect one or more Receiving the step of device head is connected to plate can repeat at any level of backbone for multiple vertebras.In some embodiments In, pedicle screw or other retaining elements may be inserted into vertebra and are connected to the receiver head of no lamellae. In the case of receiver head and plate so positioning, stable element (such as bar) can pass through receiver head to insert.Receiver Head can as needed pivot or otherwise angularly be orientated so that stable element can pass through insertion.Lock Determine element, such as limit screw or lock nut, be inserted into each receiver head in receiver head, with relative Each receiver head is angularly locked in plate and/or stable element is attached to receiver head.For the second stable member Part can repeat these steps, such as when it is expected stable in both directions., can be with close incisions after desired stabilization is realized.

Figure 15 A to Figure 15 C show guide instrument 600, and it can allow retaining element (not shown) in spinous process and thin layer quilt Before removing in insertion vertebra.When spinal cord is postoperative exposed in vertebrae plate resection, this can advantageously minimize sharp and sharp The use of apparatus.As illustrated, guide instrument 600 can include horizontal body 602, it includes clamping component 604, can adjust only Block piece 606 and guide sleeve 608.Guide instrument 600 can be connected to vertebra in a variety of ways, such as via insertion spinous process most Steady pin or screw in rearward end, or via the shown clamping structure with the first of spinous process the lateral side and the second lateral side engagement Part 604.For example, Figure 15 A show guide instrument 600, it has the central part for being arranged on the apparatus 600 for being fixedly coupled to spinous process The clamping component 604 of office.

Clamping component 604 can have various configurations, but include that spinous process can be locked in the illustrated embodiment The first arm and the second arm 610a, 610b on opposite side.Arm 610a, 610b can have various surface characteristics 612, with Improve the locking intensity, thorn, pin etc. between apparatus 600 and spinous process.Clamping component 604 can by turn knob 614 and It is selectively locked on spinous process, to promote thread spindle and cause the first cam bit 616a relative to the second cam bit 616b Slide, to reduce the horizontal range between arm 610a, 610b, as shown in fig. 15b.

First lateral end of apparatus 600 can include adjustable stop 618, such as screw member 620, and it can root Promote or retract according to needs so that the distal end 622 of stop part 618 contacts thin layer.This may insure the horizontal structure of apparatus 600 Part 602 is parallel to thin layer, as shown in fig. 15b.Alternatively, adjustable stop can be used for adapting to parallel to horizontal member 602 Other tracks.Apparatus 600 can have the guide sleeve 608 being arranged on the second lateral end of apparatus 600, and it includes guiding Arm 624.As illustrated, guide sleeve 608 has the opening 623 formed in arm 624, it is limited parallel to horizontal member 602 track.Therefore, apparatus 600 can be established into the track in thin layer, and it can be used for drilling, puncture and/or screw is inserted Enter.

It should be appreciated that apparatus 600 can change in any number of ways.For example, Figure 15 C are schematically shown with water Flat component 602', guide sleeve 608' and steady pin 604' rather than clamping component guide instrument 600'.The guide instrument 600' also has the first thin layer docking point 626a' and the second thin layer docking point 626b' that can be connected to thin layer (not shown).No Pipe apparatus 600' relative to vertebra position how, exist between guide sleeve 608' and docking point 26a', 626b' fixed Depth x.

Figure 16 A to Figure 16 E show the " exemplary of the method for screw the first ".Such as in the above-mentioned methods, this method It can be included in that patient's body forms one or more otch and retract muscle and tissue are with into targeted vertebra, such as neck Vertebra, and the degree of exposure of vertebra can be inserted directly into the tradition in lateral block rather than passing through thin layer less than wherein retaining element Code.This can reduce the wound to caused by patient and be easy to heal, because larger otch and larger in a lateral direction Dissection tend to increase patient and lose blood.In this embodiment, before laminectomy is performed, and pacify by lamellae Before on vertebra, retaining element 200A, 200B can be inserted in vertebra.It should be appreciated that this can be reduced to spinal cord Risk, because spinal cord will keep being protected by both thin layer and spinous process during the drilling and insertion of retaining element.

Figure 16 A show to be connected to vertebra, and more specifically, are connected to the guide instrument 600 of spinous process.As illustrated, bore First 700 can insert through guide sleeve 608, and can be at an angle of so that it is followed through vertebra 800 and enters vertebra The first lateral block L.M. in track.It should be appreciated that drill bit (not shown) can be such as relative to the angle of the center line of vertebra θ in Figure 11 A and Figure 11 B_MINTo θ_MAXIn the range of.Once setting desired angle using apparatus 600', then apparatus 600' can To be locked in the angle, and drill bit 700 can distally advance along the track after the anatomical structure of vertebra.Drill bit 700 Distal end can be pushed into, until it reaches desired end points, such as in thin layer or lateral block, to be formed into the marrow Path.Retaining element 200A (such as bone screws), it can be inserted by path (such as via apparatus 600' guide sleeve 608') Enter into vertebra.For the second retaining element 200B, such as bone screws, these steps can be repeated.In cervical vertebra, retaining element The farthest side position that each distal end in 200A, retaining element 200B can be positioned in lateral block L.M., such as Figure 16 B It is shown.Also as shown in fig 16b, retaining element 200A, retaining element 200B can be advanced in vertebra so that retaining element Proximal end plane lower recess, in a subsequent step thin layer will be cut at the plane.For the ease of such placement, Retaining element 200A, 200B can be the screws for having smaller head, and its maximum outside diameter is less than or equal to the thread handle of screw Maximum outside diameter.

, can be as shown in figure 16 c after 200B is inserted into vertebra by the first retaining element and the second retaining element 200A Perform Laminectomy.As in the above-described embodiment, Laminectomy can be performed in targeted vertebra, and thereon The cutting mouth of formation can by shave, formed and profile or otherwise changed, be used to be connected to the lateral of lamellae to prepare The cutting surfaces of end.Relative distance between cutting surfaces can be with same as described above.First retaining element 200A and second is solid Determine element 200B and then (for example, passing through reverse rotation in the case of screw) can be moved to nearside, as seen in fig. 16d, make Them are obtained from the thin layer end of cutting protrusion and prepares to receive lamellae.As shown in fig. 16e, then can be by lamellae 100' It is installed on prominent retaining element 200A, 200B.Especially, can be insertion into a patient by lamellae and it be positioned at installation position Put, for example, the first lateral end of plate contacts and/or received the first cut portion of vertebra and the second lateral end of plate connects Touch and/or receive the second cut portion of vertebra so that plate cuts thin layer end and the second cutting thin layer across the first of vertebra The position of end.Lamellae 100' can have any one in feature as described herein, such as allow it in compression position and Moved between deployed position to better adapt to the feature of operative site as shown in Figure 2 C and 2 D shown in FIG..In installation lamellae 100' Afterwards, one or more receiver head 140' can be connected to plate or retaining element 200A, retaining element 200B, or substitute Ground, plate 100' can be used alone as not needing the prosthese of receiver head and stable element.

Lamellae can have any one feature in various features, in order in the technology of screw first of the above-mentioned type Use.For example, in the embodiment shown in Fig. 2 C to Fig. 2 D, lamellae can be converted to opening configuration so that its flare up Engage and be fixedly attached to thereon with retaining element 200A, retaining element 200B.By another example, lamellae can wrap Retaining element 200A, retaining element 200B one or more hooks or slit can wherein be received by including.Figure 17 A to Figure 17 C are shown The exemplary of lamellae 100, it includes slit 150, for receiving the retaining element 200A protruded from cutting thin layer, 200B part.Each slit 150 can extend internally along the lateral end of axis from plate 100, and the axis is substantially with inciting somebody to action The central longitudinal axis for the retaining element 200 to be received in slit are conllinear.Plate 100 can also include corresponding to one or more One or more openings 152 of corresponding slit, locking mechanism 154 can be received by the opening in slit 150, will be fixed Element is locked in slit.For example, as illustrated, each slit in multiple slits 150 includes the opening perpendicular to its extension 152, lock screw 154 can be received in the openings.Once retaining element 200 is positioned in slit 150, then lock screw 154 can be pushed into opening 152, to engage retaining element and be fixed in slit.In some embodiments, Lock screw 154 can be included in the receiver head formed at its proximal end, wherein spinal stabilization element can be received.

Any one in this paper system and equipment can be with promoting the biomaterial of soft tissue healing to be used together, such as Submucous layer of small intestine (SIS), corium and pericardium membrane material.Such material can provide the bonding surface of enhancing, and it causes tissue Heal and can be incorporated on the surface of metal, plastics etc. around it.Biomaterial can for example extract from various sources, all Such as pig, ox, horse and the mankind.The material can be in various opening positions, such as along one or more receiver heads, along thin layer The rear surface of plate, and/or it is attached to equipment along the stable element for extending through multiple receiver heads.For example, Figure 18 is shown The receiver head 300 of lamellae 100, it has what is be connected to it and extend in backward directions from receiver head 300 Biomaterial 156.It should be appreciated that the attachment between biomaterial and equipment can be realized in a variety of ways.For example, surgeon Manually material can be navigated in equipment after by equipment such as lamellae implantation within a patient, and can be optionally The material is sewn onto patient tissue.In another embodiment, thin layer implant can be changed during manufacturing process, connect Device head and/or stable element are received, with the biological surface finish adhered to including promotion organization.

This paper equipment can be formed by the various biocompatible materialses that may be inserted into patient.Shown by non-limiting Example, the exemplary materials for forming plate, screw, receiver head etc. include stainless steel, titanium, polymer, ceramics, allogeneic Graft and/or combinations thereof.As it was previously stated, spinal stabilization element can have various characteristics, and by non-limiting Example, can be rigid, semirigid, flexible, flexible etc..By non-limiting example, for forming stable member The exemplary materials of part include stainless steel, titanium, polymer, ceramics and/or combinations thereof.

Although being described in conjunction with a specific embodiment thereof the present invention, it is to be understood that, in inventive concept as described herein A variety of changes can be made in spirit and scope.Therefore, the present invention is not intended to be limited to the embodiment, but with following The four corner that the language of claims limits.

Claims

1. a kind of spinal implant, the spinal implant includes：

Main body, the main body have preceding surface, rear surface, upper and lower surface, and the main body can position relative to vertebra, Laminectomy is performed in installation site on the vertebra, wherein described in the first lateral end reception of the main body At least a portion of first cutting thin layer end of vertebra, and the second relative lateral end of the main body receives the vertebra At least a portion of second relative cutting thin layer end of bone so that first cutting of the main body across the vertebra Thin layer end and the second cutting thin layer end；

First bone anchor receiver hole, the first bone anchor receiver hole formed in first lateral end of the main body and into Angle so that when the main body is arranged on the installation site relative to the vertebra, through the first bone anchor receiver hole And the bone screws inserted are extended in the first lateral block of vertebra；And

Second bone anchor receiver hole, the second bone anchor receiver hole formed in second lateral end of the main body and into Angle so that when the main body is arranged on the installation site relative to the vertebra, through the second bone anchor receiver hole And the bone screws inserted are extended in the second relative lateral block of vertebra.

2. implant according to claim 1, it is characterised in that be additionally included in formed in the main body at least one and match somebody with somebody Feature is closed, receiver head can be selectively coupled at least one mating feature.

3. implant according to claim 2, it is characterised in that at least one mating feature is included along the master The center mating feature that the central upper-lower axis of body is set so that when the main body is arranged on the installation site relative to vertebra When, the center mating feature is positioned on the center line of the vertebra.

4. implant according to claim 2, it is characterised in that at least one mating feature is included from the main body Central upper-lower axis laterally offset positioning the first lateral mating feature and the second lateral mating feature.

5. implant according to claim 2, it is characterised in that at least one mating feature is included in the main body The screwed hole of middle formation.

6. implant according to claim 1, it is characterised in that the upper surface of the main body limits the floating of bending Carving, the embossment of the bending are configured to receive when the main body is arranged on the installation site relative to neighbouring lower vertebra The spinous process of epipyramis.

7. implant according to claim 1, it is characterised in that the main body surrounds the central upper-lower axis of the main body Bending so that the preceding surface of the main body limit bending embossment be used for when the main body be arranged on relative to vertebra it is described Spinal cord is protected during installation site.

8. implant according to claim 2, it is characterised in that also include the receiver head with mating feature, institute State mating feature be configured to optionally be connected to the receiver head to be formed in the main body described at least one Individual mating feature.

9. implant according to claim 8, it is characterised in that the receiver head is configured to join via multiaxis Connect, monoplane connection and single shaft connection at least one of be connected to the main body.

10. implant according to claim 1, it is characterised in that the first bone anchor receiver hole is relative to the main body Region backmost where plane with the range of about 120 degree to about 140 degree angle extend.

11. a kind of method for being used to make vertebral decompression, methods described include：

The first thin layer and the second thin layer are removed from the vertebra of patient, is consequently formed the first cutting tip and the second cutting tip；

Lamellae is inserted into the patient so that described first of vertebra described in the first end ends contact of the plate cuts Cut node portion, and second cutting tip of vertebra described in the second end ends contact of the plate；

The first bone screw that first screw is inserted through in the lamellae and into the first lateral block of the vertebra；

The second bone screw that second screw is inserted through in the lamellae and into the second lateral block of the vertebra, with The lamellae is connected to the vertebra；And

After the lamellae is inserted into the patient, receiver head is attached to the lamellae.

12. according to the method for claim 11, it is characterised in that worn in first bone screws and second bone screws Cross after the lamellae insertion, the receiver head is attached to the lamellae.

13. according to the method for claim 11, it is characterised in that worn in first bone screws and second bone screws Cross after the lamellae insertion, the receiver head is attached to one in first bone screws and second bone screws Person.

14. according to the method for claim 11, it is characterised in that also include holding in multiple continuous vertebrals of backbone Row Laminectomy, and lamellae is connected to each vertebral in the continuous vertebral.

15. according to the method for claim 14, it is characterised in that also include receiver head being attached to each lamellae In.

16. according to the method for claim 15, it is characterised in that also include spinal stabilization element being inserted into the reception In device head.

17. according to the method for claim 16, it is characterised in that the stable element be positioned at the backbone center line it On.

18. according to the method for claim 16, it is characterised in that the center line of the stable element from the backbone is laterally inclined Move positioning.

19. according to the method for claim 11, it is characterised in that first cutting tip and second cutting tip The distance between in the range of about 15mm to about 30mm.

20. according to the method for claim 11, it is characterised in that when performing methods described, only about 15mm is to about The 40mm vertebra is laterally exposed to the center line of the vertebra.

21. a kind of method for treating vertebra, methods described includes：

First screw is inserted into the first thin layer of vertebra；

Second screw is inserted into the second thin layer of the vertebra；

After first screw and second screw is inserted, first thin layer and second thin layer are removed at least A part, it is consequently formed the first cutting tip and the second cutting tip；

First screw and second screw are recalled from the vertebra parts so that first screw and described second Screw protrudes from first cutting tip and second cutting tip respectively；

Lamellae is attached to first screw and second screw so that described in the first end ends contact of the plate First cutting tip of vertebra, and second cut end of vertebra described in the second end ends contact of the plate Portion.

22. according to the method for claim 22, it is characterised in that be additionally included in and the lamellae is attached to described first After screw and second screw, at least one receiver head is attached to the lamellae.

23. according to the method for claim 22, it is characterised in that the lamellae is attached to first screw and institute Stating the second screw includes the lamellae being moved to the second deployed position from the first compression position, in second deployed position The plate engages the screw.